It’s that time of year again, as Medicare’s Open Enrollment Period is inching closer. As always, it runs from October 15 through December 7, and if you have clients enrolled in Medicare, this is their annual opportunity to review their current plan and consider changes for the upcoming year.

While Medicare may seem like a “set-it-and-forget-it” program, plans can change from year to year, as can one’s health situation. That’s why it is essential to use this window to evaluate plan options. Open Enrollment is typically the only time each year to make changes to Medicare coverage. During this period, enrollees can:

  • Switch from Original Medicare (with or without Medigap) to Medicare Advantage plan – or vice versa.
    • Switching from Medigap to Medicare Advantage typically can be done without penalty or underwriting.
    • Switching from Medicare Advantage to Medigap may come with medical underwriting, meaning someone can be denied coverage or charged more based on health. However, there are four “guaranteed issue” states in which supplemental plans cannot require underwriting: Connecticut, Massachusetts, Maine, and New York.
  • Change from one Medicare Advantage plan to another.
  • Change from one Medigap plan to another.
  • Join, switch, or drop a Part D prescription drug plan.
    • Note: Lapses in Part D coverage (when you have no qualifying prescription drug insurance) may result in penalties in the form of added premiums equal to 12% per uncovered year when coverage starts again.

***Even If Clients Are Happy with Their Current Plan, Encourage a Review***

Just because a client is satisfied with their current Medicare plan doesn’t mean it will stay the same next year. Medicare Advantage and Part D plans frequently change, often in ways that can impact coverage or costs. Encourage clients to review changes to monthly premiums, covered medications and services, and provider networks.

If a person takes no action, they will remain on the same plan for the entirety of the following year (barring a qualifying Special Enrollment Period). If changes were made to that plan by the provider for the new year, beneficiaries are subject to those adjustments. In some cases, plans are eliminated from one year to next, and in such a case, they are automatically moved to a different plan should they not choose one on their own.

When 2025 prescription drug (Part D) plan details were released in late 2024, HealthView Services reported that several popular plans were eliminated altogether, while others experienced lower Medicare Star Ratings due to decreased coverage. For clients enrolled in one of these plans, this could mean higher costs or lost coverage for the prescriptions they rely on. Clients should evaluate plan options each year that include coverage for their prescription drugs.

What Clients Should Be Doing Now

  1. Review the Annual Notice of Change (ANOC): This document will be sent by their current plan and outlines what’s changing for 2026.
  2. Compare plan options on different provider websites.
  3. Consider the impact of any potential health changes during the preceding year, and if they warrant consideration of a different plan. (For example, evaluate which plans cover new prescription medications.)
  4. Ensure that providers are in-network, meaning they will accept your health plan.
  5. Evaluate Medicare Star Ratings on CMS.gov for applicable plans.

Medicare Open Enrollment is a once-a-year chance to make sure coverage still aligns with needs. Whether a client is considering a switch from Medigap to Medicare Advantage, updating their Part D coverage, or simply verifying that their current plan hasn’t changed in ways that could affect them, the time to take action is fast approaching.